EAU 2018: The FUTURE Trial: A RCT on MRI Targeted Prostate Biopsy: Comparison of Targeted and Systematic Biopsy Outcomes
For this trial, 665 men were recruited between 2014 and 2017 with prior negative prostate biopsies and a suspicion on prostate cancer (based on PSA≥4 and/or abnormal DRE) who underwent an mpMRI. Imaging was centrally evaluated by an expert radiologist using PIRADS v2. If mpMRI demonstrated PIRADS ≥3 lesions, patients were randomized 1:1:1 for MRI-targeted biopsy (cognitive TRUS, MR-TRUS fusion, in-bore MRI). In both the cognitive TRUS and MR-TRUS fusion groups, additional SB was performed. Targeted biopsy was performed initially, followed by systematic biopsy using a standardized template irrespective of the location of MRI lesions. Overall prostate cancer and significant prostate cancer (Gleason≥7) detection rates were compared using the McNemar test.
There were 224 patients (34.2%) who had a PIRADS ≥3 lesion on mpMRI. Of these, 152 underwent both targeted biopsy and systematic biopsy. Baseline characteristics included a mean age of 65.5 years, mean PSA of 11.2 ng/mL, 1.4 mean prior negative biopsies, and most commonly PIRADS 4 lesions (41.4%) on mpMRI. Using targeted biopsy, prostate cancer was detected in 47% (n=71) and significant prostate cancer in 34% (n=51). Using standard biopsy, prostate cancer was detected in 32% (n=49) and significant prostate cancer in 16% (n=24). Targeted biopsy detected significantly more prostate cancer (p=0.002), as well as significantly more significant prostate cancer (p=0.0001) than standard biopsy. In patients in whom standard biopsy did not detect prostate cancer, targeted biopsy detected prostate cancer in 21% (n=32) and significant prostate cancer in 14% (n=21). Alternatively, in patients in whom targeted biopsy did not detect prostate cancer, systematic biopsy detected prostate cancer in 7% (n=10) and significant prostate cancer in 1.3% (n=2). Systematic biopsy detected insignificant prostate cancer in 5.3% (n=8) of patients in which targeted biopsy detected no cancer.
The authors concluded that in this analysis, targeted biopsy has significantly increased detection rates for overall and significant prostate cancer compared to systematic biopsy in subjects with prior negative prostate biopsies and a persisting suspicion of prostate cancer. Few significant prostate cancers were missed when systematic biopsies would have been omitted, and less insignificant prostate cancer would have been detected.
Presented by: L Exterkate, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
Co-Authors: Wegelin O, Van Melick H, Barentsz J, Van Der Leest M, Kummer A, Vreuls W, De Bruin P, Bosch R, Somford D
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark